Faith-Based Organisations

and

HIV/AIDS Prevention and Impact Mitigation in Africa

 

 

A Desk Review by

Georges Tiendrebeogo and Michael Buykx

Amsterdam, 30 March 2004

 


Chapter 5: Christian Perspectives
to HIV/AIDS Prevention and Impact Mitigation in Africa


 

 

Box 1 disclaimer. This draft text was submitted to the Royal tropical institute (KIT) in Amsterdam as contribution to Chapter 5 of the report "Faith-based Organisations and HIV/AIDS prevention and impact mitigation in Africa" by Georges Tiendrebeogo and Michael Buykx.
The substantially changed version is available online at www.kit.nl. (Acrobat reader format). Please quote only from the KIT website, indicating the official source.

 

5. Christian Perspectives

The role of Christian FBOs in preventing the spread of HIV/AIDS (section 5.2) has predominantly been characterised by the deadlock over condom use. Christian organisations for the most part do not promote condom use, and non-Christian stakeholders have questioned the efficacy of the church's emphasis on abstinence and fidelity. In contrast, care and support seems to be dealt with effectively by Christian networks of volunteers, hospitals and health centres. It will be discussed in section 5.3.

5.1 Christian churches in Africa

Sub-Saharan Africa is the most Christian of all continents after Latin America. Roman Catholic and many Protestant Churches were founded there in the era of colonialism and missionary work. While these missions have served some colonial purposes, they have also provided the local community with a church, a school and health facilities.

Recently founded independent African churches, and some theological movements within the older churches, are engaged in a process known as "inculturation". [1]  Put simply, Africans are adapting Christian theology to their own context, synthesising Christian teachings with African values and culture. In the process, they are finding new forms for aspects of liturgy, art and theological tradition considered Western or colonial. The justification for "inculturation" is that even before the Gospel as preached by Jesus Christ in Israel 2000 years ago arrived in Africa, it had been adapted to the Greek civilization of Europe by the Apostles. [2]  Similarly, in the fight against HIV/AIDS, religious and political leaders link Christian teaching to their own African culture and tradition. The Bishops of Cameroon write: "The Church calls on men and women of good will to put all hands on deck to wage an all-out war against this pandemic, by taking part in public sensitisation, information and education activities, without hesitating to fall back on our cultural and spiritual values." [3] 

Consequently, people can no longer simply blame religious leaders outside Africa for unpopular messages. Since the Second Vatican Council, regional conferences of bishops have taken an important initiative and a certain amount of liberty in teaching the doctrine of the Catholic Church. To reconcile the Christian view on marriage with the African cultural context might constitute one of the most difficult issues: "As a matter of fact, nothing in Africa has more resisted Western Christianisation than marriage." [4] 

Box 2: "Jesus' response to stigmatization."

Whatever the reasons for stigmatization of people living with HIV/AIDS that may have occurred in Christian communities, the attitude of Jesus Christ seems to have been quite different:

When the Jews brought a woman who had been caught committing adultery, and asked for his opinion whether she should be stoned, he only said:  "Let the one among you who is without sin be the first to throw a stone at her." When all had left, one by one, he told the woman: "Neither do I condemn you. Go, and from now on do not sin any more." (John 8,3-11)

This illustration was used as a frontispiece of the Acts of the Ecumenical Pastoral Congress on HIV/AIDS in Benguela, Angola. In the process of "inculturation" this Biblical scene is transposed to the African cultural context (here: of the Mafa tribe in Cameroon). 
From the Cameroon Bible illustrations "Life of Jesus MAFA" http://www.jesusmafa.com

5.2 Christian churches’ perspectives on HIV/AIDS prevention

5.2.1 Ethical and moral teaching

Christianity is defined as a religion of love: Divine love for humankind, reflected in mutual love of human beings. This love may be celebrated in the gift of sexual intimacy by a couple. But whereas modern attitudes towards sexual pleasure tend to detach it from procreation and a lasting mutual commitment, the churches emphasise the importance of marriage in which responsibility, faithfulness, and exclusive intimacy are considered essential.[5]  All Christian denominations see the exclusiveness of sexual intimacy as an essential value of the Gospel.

Many church denominations ban the use of condoms. The Catholic Church took a strong position against condom use in 1965 when Pope Paul VI spoke out on family planning issues. The encyclical Humanae Vitae[6]  said that sexual contacts, reserved for married couples, should not be barred from transmitting life by condoms. The emotional upheaval over Humanae Vitae continues to resonate in the era of AIDS. However, in relation to AIDS, the condom issue is quite different. The churches - Catholic and Protestant alike - are aware that sex before or outside marriage is common practice but consider it contrary to their doctrine and interpretation of the Gospel. Use of a condom is perceived as a moral issue directly related to the view of the Churches on marriage and sexuality.

The churches will not change their position on condom use completely, although there is some recognition that sexual contacts may transmit a deadly virus rather than life. In this case, the commandment: "Thou shall not kill" prevails, especially in the situation of a discordant couple.

The churches also claim to be misunderstood in some aspects. They say that they are not so much objecting to the use of a condom in any situation as to its wholesale propaganda and promotion. [7]  They are especially opposed to the more extreme slogans. For example, the slogan "No limits on sex, provided it is safe" carries a "two-in-one"message. It is the first part that provokes indignation of the churches. Their view is that sexual love requires a couple to accept all the responsibilities of marriage, including the responsibility not to transmit death. The Vatican Council for the Family uses technical as well as moral arguments against condoms. [8]  However, Bénézet Bujo, a prominent Congolese moral theologian from the inculturation movement was invited to explain his view at the Conference dedicated to HIV/AIDS of all Catholic Bishop Conferences in Africa and published online at the SECAM website. [9] 

The outspoken position regarding condoms by the Catholic Church and most Protestant churches complicates HIV/AIDS prevention campaigns aimed at reducing unsafe sexual practices. However, this doctrine does not necessarily render churches unfit to promote HIV/AIDS prevention.

Christian FBOs have highlighted the importance of targeting women in preventing the spread of the disease. Many women and girls are forced to accept sexual contacts due to poverty or gender inequality. At the XIIIth General Assembly of SECAM in Dakar, October 2003, the Symposium of Episcopal Conferences of Africa and Madagascar HIV/AIDS was one of the major topics. [10]  A plan of action was accepted focussing on gender issues in order to protect girls, young people and women from their vulnerability to HIV infection.

Box 3: The fleet of hope


The fleet of hope A prevention campaign which is compatible with the general UNAIDS strategy, is the so-called "Fleet of Hope". It was developed in Tanzania by Bernard Joinet, a lecturer in clinical psychology at Dar-es-Salaam University, where he served as well as a Roman Catholic Chaplain for many years.  He saw in distress how the epidemic spread dramatically whereas various stakeholders sent conflicting messages of prevention. He then elaborated a campaign based on visual images, inspired by Noah's Ark.
  There are two basic assumptions:

  • People are more sensitive to emotional imagery and pictures than to theory and factual text.

  • The responsibility of a national government is different from the responsibility of the various groups in society.

The message consists of 4 sections, in all 44 posters:

1. AIDS is like a Flood (1-18)
The AIDS pandemics is being compared to a flood that rises up and up and swallows up millions of people. One can escape only if one climbs on board of the "Fleet of Hope": an inseparable combination of  three boats that may save from death by AIDS: "the Fidelity" "the Abstinence" and "the rubber lifeboat" (condom). These boats are options in determined situations. When the situation changes, it is better to change boats rather than to get back into the water.

2. Different responsibilities (19-24)
The national government should encourage people to board a boat whatsoever. Groups in society, for example families or religious groups, are not under any obligation to present all options as equal alternatives in view of their values.
N.B. The prevention deadlock occurs whenever the government promotes one particular boat. If exclusively "safe sex" is promoted, moral values are implicitly being imposed on the entire population. As a counterreaction the churches and other groups are provoked to give their views on that boat from a moral point of view.
On the other hand, the churches, because of their understanding of the universal mission of the Gospel, might not agree that their message were exclusively meant for their followers or parish members.

3. Individual options (25-36)
Looking closer who is on board of any of the boats in a determined situation, helps to do away with stereotypes. The 'Abstinence' is not only for monks, but an option everyone has stayed on, at least in his early youth. And the 'Condom' is not only for sex workers: also a faithful discordant couple may decide to use it when the "Fidelity" option is no longer safe. And everyone may at a determined moment have to change from one boat to another unless he takes the risk of drowning. The typical example is of the "condomizing womaniser" who runs out of stock: he can either drown or board the "Abstinence" until the pharmacy opens next morning.


4. Psychological constraints (37-44)
The real problem lies with those who don't want to board a boat, for irrational convictions like "AIDS is punishment for a sin" or "I am bewitched". And many people, especially women, cannot board a boat, being too poor and too dependent on their partners to make free choices.

Experiences
This campaign, which started in an a-religious association, was promoted by UNAIDS all over the world through its branches and adopted by many public health services, especially in Africa. It has aroused suspicion in some faith groups as if the Fleet were meant to prove that all options, especially the rubber lifeboat one, would be equally acceptible irrespective of any circumstances. It could be misused, and sometimes it is.
It has been used successfully by churches in various African countries: in Burkina Faso it was translated into French, and adapted to a group discussion game with a tapestry and character cartoons. In Angola, it was translated into Portuguese, and reposted on the internet http://www.mh2.dds.nl/en/fleet/index.htm. In D.R.Congo it was used to open discussion about behaviour change and lead the public even to question the over simplified marketing slogans of condom sellers.
In general, it is felt that the campaign in itself doesn't impose any moral view, and focuses precisely on circumstances and individual situations, in order to make moral decisions possible. This openness has helped to overcome the deadlock on both sides, since no party likes to be compared to a war-ship wasting her energy in shooting torpedo's at other boats instead of saving lives. [12] 

The association "La Flottille de l'Espoir" [11]in France facilitates worldwide distribution of the 44 posters, a pedagogic handbook, and the discussion game.



The Church and secular services do not operate in isolation. As the Fleet of Hope example shows, FBOs do find ways to stimulate safe sex practices. Similarly, most secular HIV/AIDS prevention campaigns no longer limit their message to promoting condoms. The other two main prevention strategies - abstinence, and fidelity to one un-infected partner -are neither easy nor popular. But the Churches have a comparative advantage in preaching them. Given the social context and value system of the Churches, these strategies can be promoted with credibility.

A growing trend exists in some Churches to allow the use of condoms as the lesser evil", if sexual contact will put the other partner at risk of mortal danger. [13]

"There are couples where one of the parties is living with HIV/AIDS. In these cases there is the real danger that the healthy partner may contract this killer disease. The Church accepts that everyone has the right to defend one's life against mortal danger. This would include using the appropriate means and course of action."

[14]

 

The practice is not entirely unchallenged within the Church as some fear that allowing exceptions may be used to promote family planning. [15]

Abbé Alexandre Mbengue, the director of a major priest seminary in Senegal, is quite clear on this matter. He says that the "Loi de la Gradualité" has to be applied if abstinence is not an option for two married people: using a condom is preferred to transgressing the commandment: "Thou shall not kill" [16]

. The Senegalese bishops’ conference saw no difficulty in quoting this and concluded positively that: "The use of condom could be a lesser evil. [17]

"

Bishop Kevin Dowling from the heavily HIV-infected mining district of the Rustenburg Diocese in South Africa, is the initiator of the AIDS Office of the Southern African Catholic Bishops' Conference. He goes even further: "We live in a world where many people choose not to live according to the values espoused by the church. And especially in our southern African region, there are so many poor people, women and girl children whose socio-economic and cultural situation takes away their options and choices. In those situations, I believe that people living with HIV must be invited and challenged to use a condom in order to prevent the transmission of potential death to another person, or to protect themselves from infection, especially in abusive and destructive relationships." [18]

Bishop Dowling represents a growing minority opinion among Christian theologians. There is an increasing awareness of the vulnerability of women, many of whom are not able to negotiate their sexual relations.

Box 4 Pastoral congress on HIV/AIDS in Benguela Diocese, Angola

Pastoral congress on HIV/AIDS in Benguela Diocese, Angola
 

The Fleet of Hope prevention campaign (see Box 3) being presented at the first pastoral congress on HIV/AIDS in Benguela Diocese, Angola.  Proceedings: www.aids-church.tk

 

The churches also play an important role in education, managing schools, and organising training sessions. The final resolution of the second "Colloquium on AIDS and Religion" in Senegal states: "It is necessary to intensify the effort in literacy in order to promulgate information on HIV/AIDS. It is necessary to intensify collaboration between the various social structures of the Church: Health, Education, Caritas, Women empowerment." [19]

Father Emílio Sumbelelo of the Diocese of Benguela, Angola stresses the importance of church schools, where education and role models help young people in their choices. [20]

In other instances, Christian values can have a negative impact on AIDS prevention in schools. An Action AIDS report on schools in Kenya states: "Teachers exercise a self-imposed veto on sections of the curriculum that deal with any practices they feel will offend local beliefs. In Kenya particularly, Catholicism has a big effect on the way HIV is taught and teachers view this as having a negative impact". [21]

This apprehension over causing offence leads teachers to skip HIV altogether, or to address it in a technical way, leaving out issues of sexuality, human values and stigma. The Plan of action of SECAM the PAN-African synod of Catholic bishops regarding HIV/AIDS may help them to overcome that fear. [22]

5. 3 Christian churches' perspectives on HIV/AIDS impact mitigation

5.3.1 Christian churches and HIV/AIDS medical and social care and support

A strong current of helping others runs through Christian doctrine, from Jesus Christ's unconditional love for lepers [23]

to the "works of mercy" concept, which led the church to care for orphans, the sick and the poor in the Middle Ages. Today, Christian churches assume a large role in providing health care. In many African villages and towns, the mission hospital or dispensary represents a welcome presence of the church.

Even when the moral issues created by the prevention campaigns initially led some church leaders to remain silent on the AIDS pandemic - or even to oppose action undertaken by others - the response of their medical staff to the explosion of patients was more than adequate.The Catholic Church claims to deliver 19% of all health service and 25% of all social service related to HIV/AIDS. [24]

Home-based care has emerged as an important aspect of Christian care for PLWHA. The move was necessitated by the magnitude of the crisis, in which hospitals were running out of space. The inner cohesion of a congregation or parish combined with medical know-how, trained staff and external networks is a strong asset of the churches. Volunteers for Christian FBO home-based care tend to be more motivated than their secular colleagues. This may be due to the shared value system of the caregivers. Liebowitz coined the theory of "the social capital of FB0s". He argues that since in many religious institutions members regularly engage themselves in activities that build trust and community, the members are more likely to use these religious institutions to accomplish social goals. [25]

Box 5: Ndola home based care

 

   


Box 8: Canon of the Anglican Church of Uganda declares to be HIV-positive.

 

 

 

An important stigma fighter is Gideon Byamugisha of the Anglican Church of Uganda. He addressed the ecumenical advocacy alliance HIV/AIDS strategy group on the launch of the campaign on HIV/AIDS world AIDS day 01-12-2001:

"My own church continues to take up its part in this campaign by challenging the stigma that is usually attached to HIV/AIDS. In a few days I will be made a Canon of the Anglican Church. You may ask, "What does this have to do with HIV/AIDS and stigma?" The answer is simple yet painful…you see I am living with HIV. (...) I can testify that my church cares. She did not throw me out when I disclosed that I was HIV positive way back in 1992. Instead, she supported me in the task of developing an HIV prevention and AIDS care program that integrates issues of sex, sexuality, and sexuality in worship; in Christian literature and in ministry with children, young people and parents. As church, we have worked together (albeit in a small way) in: I) extending subsidized HIV counseling and testing services to those wishing to know their HIV status; ii) initiating post-test HIV support clubs for continuous counseling, social and spiritual support to those living with HIV/AIDS; iii) training and commissioning "Good Samaritan" home care teams among children, youths, and adults in the church; and iv) starting health units where there are none and strengthening those that lack medicines and equipment."[41]

 

Canon Byamugisha subsequently developed AIDS liturgy to span the church liturgical year and keep HIV/AIDS and those infected and/or affected by it in the liturgical prayers of the church. And he mobilized church leaders "Christian church leaders need to be met where they already have strengths, in using the Bible, before training about research and statistics"[42]

 


Box 1 disclaimer. This draft text was submitted to the Royal tropical institute (KIT) in Amsterdam as contribution to Chapter 5 of the report "Faith-based Organisations and HIV/AIDS prevention and impact mitigation in Africa" by Georges Tiendrebeogo and Michael Buykx.
The substantially changed version is available online at www.kit.nl. (Acrobat reader format). Please quote only from the KIT website, indicating the official source.

 


 



[1]           Baur, John, 2000 years of Christianity in Africa (Nairobi 1994); the African Bible (Nairobi 1999).

[2]          Pondy, P. (Direction Catholic Schools Yaoundé) "Why an African Christ?" http://www.jesusmafa.com/anglais/noir.htm

 

[3]        NECC (1999), Cameroon bishop's declaration on AIDS, Yaoundé, 8 December 1999, p.9

 

[4]        Baur (1994) 469.

 

[5]        NECC (1999), p.6

 

[7]        Southern African Catholic Bishop's Conference, "A Message of Hope", July 30th, 2001 http://www.sacbc.org.za/aisdpubhope.htm

 

 

[9]           Bénézet Bujo, "Quelle morale pour le problème du SIDA en Afrique?"

 http://www.sceam-dakar.sn/moralesidaafrique.htm

 

 

[10] The church in Africa in face of The HIV/AIDS pandemic: "our prayer is always full of hope" Message issued by the Symposium of Episcopal Conferences of Africa and Madagascar, Dakar 2003http://www.jesuitaids.net/secam-aids2003e.htm; http://www.sceam-dakar.sn/resolutionsfinales.htm

 

 

 

[11]       Association Flottille de l'espoir, 103, av de Villiers, 75017 Paris – France. www.fleetofhope.tk

 

[12]       Joinet, Bernard, Survivre face au  SIDA en Afrique (Paris 1994)

http://www.vihinternet.org/afrique/savoir/flotille.htm (French version)

http://www.kit.nl/information_services/exchange_content/html/1996_2_fleet_of_hope.asp (English description)

www.sida-igreja.tk (Portuguese web version)

 

[13]       Suaudeau, Mgr. Jacques (2000), "Prophylactics or Family Values? Stopping the Spread of HIV/AIDS", L'Osservatore Romano,

19 April 2000; http://www.ccli.org/reviews/Suaudeau.shtml#Article;

 

[14] Southern African Bishops' Conference "Message of Hope" 30 Jul 2001.

http://www.sacbc.org.za/aisdpubhope.htm

 

[15]    www.condoms4life.org; Jon D. Fuller and James F. Keenan "Tolerant Signals:
The Vatican's new insights on condoms for H.I.V. prevention" America, September 23, 2000 http://www.americapress.org/articles/fuller-keenan.htm; http://www.ccli.org/reviews/Suaudeau.shtml#Clarification

 

 

[16]       Mbengue, A. (1996), "Ethique Chrétienne et SIDA: Promouvoir la Vie" in SIDA Service, National  AIDS Programme; USAID (1996), Actes du Deuxième Colloque National SIDA et Religion, Réponses de églises Chrétiennes, SIDA Service Report, Dakar, 9-10 January 1996, p.52

 

[17]       SIDA Service, National AIDS Programme, and USAID (1996), 'Déclaration de la conférence des Evêques  du Sénégal,' Dakar, 10 January 1996; Actes du Deuxième colloque national SIDA et Religion, Réponses  de églises Chrétiennes, SIDA Service Report, Dakar 9-10 January 1996, p.104

 

[18]    Byamugisha, Gideon and Steinitz, Lucy et al. (2002), "Joumeys of Faith" (TALC St Albans), p.94

 

[19]       SIDA Service (1996), Resolution Finale, Actes du Deuxieme colloque national SIDA et Religion, Réponses de églises Chrétiennes , SIDA Service Report, Dakar, 9- 10 January 1996, p. 12

 

[20]       Sumbelelo, Father Emilio (2002), "'A prevenção do HIV-SIDA nos pronunciamentos da igreja", Benguela, Angola; http://huizen.dds.nl/~mh2/ port/sida/sumbelelosida.htm

 

[21]       Boler jania (2002), "The sound of silence - difficulties on communicating on HIV/AIDS in

schools", Action AID, London http://www.actionaid.org/resources/pdfs/soundofsilence.pdf

 

[22]       The church in Africa in face of The HIV/AIDS pandemic: "our prayer is always full of hope" Message issued by the Symposium of Episcopal Conferences of Africa and Madagascar, Dakar 2003 http://www.jesuitaids.net/secam-aids2003e.htm; http://www.sceam-dakar.sn/resolutionsfinales.htm

 

 

 

[23]       Fr. Ezequiel Faria, "Cristo não veio explicar o mistério do sofrimento, mas veio sofrer connosco", Benguela,

7 December 2001,  http://www.sida-igreja.tk

 

[24]       Message of Card. Javier Lozano Barragán for the World Day of AIDS (November 30, 2003) http://www.vatican.va/roman_curia/pontifical_councils/hlthwork/documents/rc_pc_hlthwork_doc_20031130_barragan-aids_it.html;

 

[25]       Jeremy Liebowitz, "The impact of faith-based organizations on HIV/AIDS prevention and mitigation in Africa", (Natal, 2002) http://www.und.ac.za/und/heard/publications/FBOs%20paper_Dec02.pdf p. 17

 

[26]     http://www.bathwells.anglican.org/mission/wm_lect04_1.pdf

Blinkhoff, Petri, Bukanga, Esaya et al., (1999) "Under the Mupundu Tree Volunteers in Home care for people with HIV/AIDS and TB in Zambia's Copperbelt", Action AID, London  http://www.thebody.com/unaids/wac2002/countering_stigma.html#8

http://www.unaids.org/bestpractice/digest/files/Volunteersinhomecare.html

http://europa.eu.int/comm/development/publicat/courier/courier189/en/en_002_ni.pdf

 

[27]    Byamugisha and Steinitz et al. (2002) p.24

 

[28]       Kelly, M. J., "What AIDS does to Education" http://www.jesuitaids.net/whataiddoes.htm

 

[29]       Haendler, R. (2001), "Pastoral roles in HIV and AIDS prevention and Care" in UNAIDS Round Table on "Faith-based strategies, achievements and challenges in their response to the HIV/AIDS Pandemic", p.5; International Confèrence on STDs and AIDS, Burkina Faso, 12 December 2001

 

[30]       "Increased Partnership between Faith-Based Organisations, Govemments and Inter-Govenunental  Organisations", Statement by Faith-Based Organisations facilitated by the World Council of Churches for the UN Special General Assembly on HIV/AIDS, 25 - 27 June 2001

    http://www.wcc-coe.org/wcc/what/mission/ny-statement.html

 

[31]       Vitillo, Robert (1994), "Theological challenges posed by the global pandemic of HIV/AIDS", Boston   http://www.natcath.com/NCR_Online/documents/VitilloHIVreport.htm

 

[32]       Ibid. Liebowitz (2002), p. 20

 

[33]       Ibid. Vitillo, Robert (1994)   

 

[37]       Campbell, Ian D., HIV/AIDS, Stigma and Religious Responses, An overview of issues relating to stigma and the religious sector in Africa

http://www.ccih.org/compendium/HIV-AIDS,%20STIGMA%20AND%20RELIGIOUS%20RESPONSES.html;

Delle, Edmund N., Fellowship of Christian Councils and Churches in West Africa at UNAIDS Round Table, December 2001, "Combating and dismantling STIGMA – what is working and what has not worked"

 

[39]       Ibid. Haendler, R. (2001)

 

[42]    Byamugisha, Gideon "Mobilizing and Equipping Church Leaders in Uganda" http://ccih.org/forum/0110-08.htm

 

Box 1 disclaimer. This draft text was submitted to the Royal tropical institute (KIT) in Amsterdam as contribution to Chapter 5 of the report "Faith-based Organisations and HIV/AIDS prevention and impact mitigation in Africa" by Georges Tiendrebeogo and Michael Buykx.
The substantially changed version is available online at www.kit.nl. (Acrobat reader format). Please quote only from the KIT website, indicating the official source.

last revision of this page: January 1st, 2007.